Question:
As a dentist, a patient has come to see you because of a toothache and after your examination of her you would like to take a radiograph to confirm the diagnosis. Your patient believes X-rays cause cancer and refuses. How would you deal with this situation?
Discussion:
The issues here are around autonomy, informed consent and evidence-based practice.
Here, the patient is expressing her right not to have an x-ray. However, the conflict is that you cannot make a clear diagnosis without a radiograph.
Basis of your Expert Answer:
You would sit the patient up after your examination and face her at eye level in order to establish communication.
It is important to remain non-judgmental and empathetic to the patient’s concerns.
You would ask the patient what her concerns about dental X-rays are. It could be that she thinks she may be pregnant and therefore x-rays would harm her baby.
You would follow up with a discussion of why you require a radiograph and the risks and benefits of dental x-rays and that you follow professional scientific guidelines. (As a bonus, you could mention IRMER guidelines ( Ionising Radiation Medical Exposure Regulations) and that dental X-rays expose us to a mere fraction of the total natural environmental radiation we are exposed to in a year. )
You should also mention that GDC standards stipulate that you should always put the patient’s interests first and in this regard if she does not consent to a radiograph, you then have to make a decision as to whether you can still continue with her treatment.